Healthcare Provider Details

I. General information

NPI: 1629040605
Provider Name (Legal Business Name): ALLAN T BOMBARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 HEALTH CENTER DR
SAN DIEGO CA
92123
US

IV. Provider business mailing address

2870 EVERGREEN ST
SAN DIEGO CA
92106
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-4167
  • Fax: 858-939-4983
Mailing address:
  • Phone: 619-543-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberG76627
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number181863
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberF9219
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: